Microsoft Word - 3.nFORM_ServiceReceipt (OMB NSC)

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OMB NO.: 0970–0566; EXPIRATION DATE 07/31/2029

MATHEMATICA

nFORM Client Profile (screen C3)

ACF will remove the statement indicating whether or not a client has been screened for intimate
partner violence or teen dating violence from the Client Information box on the Client Profile.
This statement previously appeared below the Primary Language indicator.

OMB NO.: 0970–0566 ; EXPIRATION DATE 07/31/2029

MATHEMATICA

nFORM Screens C7. Add/Edit Service Contact and C12. Add/Edit Referral

ACF will modify screens C7 and C12. On both screens, an optional field labeled “Domestic
Violence/Intimate Partner Violence (DV/IPV) Screening” will be added to the Assessment
section on the upper left, immediately below “Employment/Job Readiness”. In addition, the
existing field labeled “Domestic Violence/Intimate Partner Violence” will be revised to
“Domestic Violence/Intimate Partner Violence (DV/IPV) Services”.
Arrows on the screen shots below indicate where these changes will be made.

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OMB NO.: 0970–0566 ; EXPIRATION DATE 07/31/2029

MATHEMATICA

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OMB NO.: 0970–0566 ; EXPIRATION DATE 07/31/2029

MATHEMATICA

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